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Rolling Stone Magazine Rolls the Truth

  Recently, I was with a group of good friends whom I have known for 20 years.  They are a spirited group of unabashed liberals.  I doubt any of them have ever voted for a Republican, or ever would.  Of course, we have a secret ballot in this country so we never know for sure.  Publicly, at least, they profess unwavering fealty to the Democratic Party. I regard myself as a political independent, although I tend to vote Republican.  However, when I am amid this group of left-leaners, they look to me for the ‘far right’ view on the issues of the day.  Yes, we have different views on the proper role of government and the judiciary, but I don’t look to Ted Cruz or Sarah Palin for political inspiration. During our conversation, the recent Rolling Stone journalistic debacle that detailed an alleged rape at University of Virginia came up.  Immediately, the prevailing liberal talking point was offered up to the group, expecting acclamation.   “This Rolling Stone retraction is

Ready for the Silent Treatment?

When moved to do so, I wander off the medical commentary pedestal to share thoughts with readers.  This is one of those occasions.   I had a singular experience last weekend that impacted me. Most of us can agree that there is a paucity of silence in our world.  There is noise and static everywhere filling our time and space with cacophony.  Television news shows have become performances where we watch panels of pundits who appear as clucking hens.  Try to find a coffee shop that isn’t blaring music.  Even sports games on television have every nanosecond filled with barkings from commentators.  Can’t we just enjoy the play? Last Sunday, I went to a Quaker Meeting House for the first time, accompanied by my daughter Ariella, representing our family.  There was no speaker, ushers, music or program of events.  The room was set up with chairs in each half that faced each other.  Folks took their seats and remained quiet.  At first, I was disquieted by the quiet, impatient for some

What's the Cause of Chronic Abdominal Pain?

I see patients with abdominal pain every day.  Over my career, I’ve sat across the desk facing thousands of folks with every variety of stomach ache imaginable.   I’ve listened to them, palpated them, scanned them, scoped them and at times referred them elsewhere for another opinion.  With this level of experience, one would suspect that I have become a virtual sleuth at determining the obvious and stealth causes of abdominal distress.   I wish it were the case. Some Cases Defy Sleuthing The majority of cases of chronic abdominal pain that I – and every gastroenterologist – see will not be explained by a concrete diagnosis.   Sure, I’ve seen my share of sick gall bladders, stomach ulcers, diverticulitis, bowel obstructions, appendicitis and abdominal infections, but these represent a minority of my afflicted patients.  Patients with acute abdominal pain are more likely to receive a specific diagnosis, such as those listed above.  However, patients who have abdominal

Whistleblower Holiday Cheer 2014!

T’was the week before Christmas And all through the House, Boehner was stirring No longer a mouse The Senate as well In GOP hands Girding for battle With toothless demands. No government shutdown That never played well. Impeachment would surely Damn them to hell. Executive orders, No self-deport. Why diss the Congress? He does it for sport! In 2016, Are Repubs aware, That they need a candidate With Romney’s hair? GOP are no saints They carp and complain, Blaming Obama With dripping disdain. “He’s a king or a czar. It’s all been a ruse.” We know this is true It was on Fox News. So will there be progress? Will they join hands? Can we have hope? As we watch from the stands? Or can we expect, More of the same, Bickering, sniping And pointing the blame? Will Jeb give the nod? Can Hillary lose? Or Dancer or Prancer, Or maybe Ted Cruz? Sit back and relax, For the start of the show,

Does Quality of Colonoscopy Depend on Time of Day?

Over the past decade, there has been renewed effort to increase the quality of colonoscopy. New data has demonstrated that colonoscopy quality is less than gastroenterologists had previously thought. Interestingly, colonoscopy is less effective in preventing colon cancers in the right side of the colon compared to the left side. Explanations include that some pre-cancerous polyps in the right side of the colon are more subtle to recognize and that the right side of the colon has many hidden areas that are difficult to visualize. New examination techniques and equipment are addressing these issues. The goal of colonoscopy is not to detect cancer; it is to remove benign polyps before they have an opportunity to become malignant. A new measure of medical ‘quality’ is to record how often gastroenterologists (GIs) remove polyps from their patients. For example, if a GI only detects polyps in 5% of patients, which is under the quality threshold, then someone will conclude that this physici

Should Your Doctor Consider Medical Costs?

This blog is devoted to an examination of medical quality.  Cost-effectiveness is woven into many of the posts as this is integral to quality.  Most of us reject the rational argument that better medical quality costs more money.   Conversely, I have argued that spending less money could improve medical outcomes.  Developing incentives to reduce unnecessary medical tests and treatments should be our fundamental strategy.  Not a day passes that I don’t confront excessive and unnecessary medical care – some of it mine - being foisted on patients.  At one point in my career, I would have argued that physicians and hospitals were motivated only to protect and preserve the health of their patients, but I now know differently.  Payment reform changes behavior. As an example, it is impossible for a patient with a stomach ache who is seen in an emergency room to escape a CAT scan, even if one was done for the same reason months ago.  I saw a patient this past week with chronic and unexp